Provider Demographics
NPI:1417175126
Name:CAMPOS, ELIZABETH (PT CLT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:PT CLT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:G
Other - Last Name:CAMPOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT CLT
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9998
Mailing Address - Country:US
Mailing Address - Phone:917-202-3652
Mailing Address - Fax:
Practice Address - Street 1:231 WASHINGTON AVE
Practice Address - Street 2:ST MARKS PHYSICAL THERAPY
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-746-0276
Practice Address - Fax:516-248-4661
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0273461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist